Gabbs residents to go without ambulances
by Jason Hidalgo
August 5, 2006

A dispute between Nye County officials and a group of volunteers has left the town of Gabbs and its residents, including elderly citizens with chronic health problems, without its two ambulances.

The county pulled the two ambulances after officials determined that Gabbs didn't have enough licensed volunteers to meet state requirements for running a volunteer emergency medical service or EMS.

The move leaves Tonopah, which is more than 100 miles away, as the closest place with ambulance service. Volunteer crews from Hawthorne, about 60 miles away, told county officials that they don't have enough resources to cover both their area and Gabbs. The only other option for transport from Gabbs is Care Flight.

The pulling of the ambulances hasn't sat well with residents such as 68-year-old Pat Thompson, who's still in disbelief over the prospect of an ambulance having to respond all the way from Tonopah.

"It concerns the hell out of me," said Thompson, a Gabbs resident of 21 years. "Ridiculous doesn't even begin to cover it. It's insane."

Thompson has reason for concern. Not only does she have heart problems, but she also suffers from chronic obstructive pulmonary disease and uses an oxygen tank to help her breathe. Just three weeks ago, Thompson had to be taken to a hospital for breathing difficulties.

With Gabbs no longer having its ambulances, Thompson's husband ended up driving her to Fallon, 80 miles and more than an hour away. Thompson was diagnosed with a severe bronchial infection.

"As long as my husband is healthy and can drive me to the hospital, then I guess it's OK," Thompson said. "But I do not want to die on him on the way. I would like to at least have a second person there who can administer CPR and help out, which is what an ambulance is good for."

Rural challenges

The loss of Gabbs' ambulances underscores the ongoing challenges faced by rural Nevada communities that rely on volunteers to staff emergency services.

Nevada typically requires that volunteer crews must have two licensed emergency medical technicians or EMTs on every ambulance run. Licensed EMTs require more training and are allowed to provide more emergency services than basic first responders.

Such statutes are in place to ensure public safety, said Fergus Laughridge, program manager for Nevada's EMS program, which enforces EMS standards for the state.

"You can't have people who are not properly credentialed out there with all this equipment trying to take care of folks," said Laughridge. "It's a huge liability for the county."

Some volunteers, though, complain that the requirements are unrealistic for a small town like Gabbs. Currently the town has only three licensed EMTs, which the county found insufficient in meeting state staffing guidelines for providing 24-7 coverage.

"We're a town of 312 people — including children," said former district fire captain George Muns, who has spearheaded complaints against the county. "Most of our volunteers have to come out of work. (A large part of our population are) elderly people, including ones with significant health problems. Tell me how we're going to get that much coverage."

More than 26 percent of Gabbs residents are 55 and older while more than 30 percent are 19 and younger according to the 2000 census.

To address those concerns, Nye County lobbied the state to provide a "variance" or exception for Gabbs, said Brent Jones, Nye County's director of EMS. The variance allows Gabbs to do ambulance runs with just one licensed EMT instead of two while a licensed first responder drives the ambulance.

But even after the variance was approved for Gabbs, the town still wasn't able to come up with enough licensed volunteers to adequately staff its volunteer EMS program and meet state regulations, which Laughridge confirmed.

"We have really attempted to make things work in Gabbs," Jones said. "But the biggest problem is volunteerism and having enough trained people to fill the schedule."

Differing opinions

The loss of the ambulances also isn't sitting well with Jan Basinger, a volunteer and vice chairman of Gabbs' town advisory board. The acrimony between both camps has gotten to the point where Basinger has received a warning from Jones' lawyer about potential legal action, citing baseless accusations made against the county's EMS director. Basinger, meanwhile, claims the town isn't getting the same attention other areas are because of its small size and feels it's being singled out.

"Nobody's helping us," Basinger said. "There's nobody we can turn to — nobody."

Jones stresses, though, that Gabbs isn't being singled out. Ione doesn't have volunteer EMS because it doesn't meet state staffing requirements. The nearby Yomba Indian Reservation got its ambulance pulled last year for similar reasons to Gabbs. Yomba, though, is on track to re-establish its ambulance service because of renewed interest among its residents, who have started attending the county's training courses.

As proof of the county's efforts to assist Gabbs volunteers, Jones points to the town's fire station, its new fire truck and its rescue vehicle, which also has a new trailer. The fact Gabbs was provided two ambulances — pretty good for a town its size — shows the county's support, Jones said.

The county also held three classes in the last 18 months to train volunteers in Gabbs to meet state requirements. But only one person attended the whole time, Jones said. The county even offered to pay lodging expenses for people to attend courses in Smoky Valley. But none of these classes will make a difference if people don't take it, Jones said.

Jones said the atmosphere has gotten so negative from the ongoing dispute that it's driving others away.

"We have a lot of people who have gone away from our classes saying they don't want to be involved with all this turmoil and drama," Jones said. "We have to get the people causing all this tension to step up to the plate."

Meanwhile, Muns — a certified instructor under the American Society for Healthcare Engineering and National Safety Council — ran his own class in Gabbs, and had six people finishing the course.

But since Muns' class wasn't overseen by the county, the attendees can't be licensed until the state verifies that the training provided was satisfactory.

"They have to go through a permitting process with the state in accordance with Nevada revised statutes," said Patty Winters, Nye County's EMS coordinator. "We have to meet state regulations."

Getting back on track

Caught in the middle of the ongoing dispute between both camps are EMTs Connie Stinson and Neva Ikehorn, who have tried to remain neutral on this issue.

Since Gabbs' ambulances were pulled, the remaining EMTs have been responding with the volunteer fire crews. Sometimes, they'll even respond in their own private vehicles, Ikehorn said. They can still provide medical assistance on the scene, but they can no longer transport patients, said Stinson, Gabbs' current ambulance coordinator. So far, they've responded to four incidents since the ambulances were pulled.

The dispute between both camps along with the pulling of the ambulances have made a tough job even tougher, both EMTs said. It's also made recruiting and retention a lot harder as people stay away because of the fighting and politics going on, both added.

It shouldn't have come to this if cooler heads had prevailed, Ikehorn said.

"This could have been prevented," Ikehorn said. "It's been extremely difficult. Our lives have been kind of on hold, and it's been hard on our families. A third of our community are seniors, and it's been really hard on them, too."

Ikehorn said he doesn't agree with everything that Nye County has done. But she also understands that rules and regulations have to be followed, Ikehorn said. Both EMTs also gave the county credit for trying to help, including seeking the special variance for Gabbs and its support for the remaining volunteers.

The good news is that Gabbs' fourth EMT will be returning to the town soon. The prospects also look good for the state certifying the first responders who finished Muns' class.

To help solve manpower problems, the state is willing to look at any options, Laughridge said, including having Gabbs and Yomba pool resources for a joint service.

The question now is whether all parties can put the acrimony behind them and work for the good of the community, Stinson said.

"We need to have everyone working together again like we did in the past," Stinson said. "We have a nice place to raise a family, go to work and retire, and we just need to get things back to the way they used to be. I think that's possible with a little bit of work. We all just have to be a little more patient, put the bad feelings behind is and move forward."

Your Turn: Politics get in the way of services
by Nathan Giesbrecht

Reno Gazette-Journal op-ed
April 24, 2006

I am responding to the well-written article posted on March 26, 2006 by Jim Sloan and Steve Timko in the Reno Gazette-Journal. The unfortunate basis of the article is that the state of Nevada has the worst EMS response time in the nation. However there may be some hope in the better utilization of rotor and fixed-wing EMS aircraft, an option not mentioned in the article.

I work for Calstar based out of South Lake Tahoe (close to the Nevada border) where severely injured patients are frequently transported from remote regions to the nearest qualified trauma center in Reno. In the EMS scheme of things trauma patients have a "golden hour." This means their best chance for survival is to receive advanced medical care within 60 minutes of their critical injury. For example, a helicopter flight from the Tahoe Basin to Washoe Medical Center, the nearest available trauma facility, is approximately 22 minutes; whereas by Code 3 ground ambulance you are looking at an hour with good weather. You do the math. Not to mention during your flight, just like with the paramedics in the ambulance, there are highly trained personnel able to deliver life-saving treatments en-route that may save your life even before you arrive at the trauma room.

My point is that there are helicopter and fixed-wing companies nearby capable of reducing these prolonged reaction times and improving patient outcomes, a concept that should be paramount. However recent state regulations have made it nearly impossible for extremely qualified rotor wing organizations to establish bases in affected Nevada counties and deliver this imperative care to patients.

Unfortunately it seems the legislative bodies believe that patient care is less important than the fear of lost revenue from competing EMS helicopter companies, even though their response time in certain instances to critically injured patients would be quicker than Nevada-based companies (themselves fully qualified to deliver excellent patient care, but sometimes based farther away from the scene or busy on other emergency calls). Interestingly, California does not practice such protectionist policies; EMS response is, by law, based on the closest available resource.

There is a pervasive politicized process in Nevada that obstructs the dissemination of ideal patient care. Our company has been threatened with litigation by EMS authorities if we serve patients in their county. Furthermore, hospital staff at one facility in Nevada has been threatened with disciplinary action if they call an air medical provider other than Care Flight, even if it could expedite their patient to a specialty center more quickly. To me this reeks of monopolization and anti-competition, creating distrust and rivalry between the companies. But more importantly, the public has a right to expeditious and quality care, and that is what ultimately suffers.

In summary, I'm certain that improved collaboration between air ambulance organizations will not fix all the problems related to Nevada's poor EMS response time, as there are many other factors involved. However I believe it is related to Nevada's poor EMS response time, as there are many other factors involved. However I believe that removing the political obstruction between quality EMS rotor companies can ultimately be a step in the right direction. We in the aero medical profession do this job because we want to deliver specialized critical care to the citizens of California and Nevada.

To me that is more important than fickle politics going on behind the scenes.

Nathan Giesbrecht is an employee with Calstar.

Copyright © 2006 Reno Gazette-Journal

Failing to meet kids' basic needs
By Andrew E. Kelly
Reno Gazette-Journal Guest Editorial / March 30, 2006

Who is failing the youth of Reno/Sparks? Can the public school system really "Leave No Child Behind"? I believe that the true failure in Washoe County is much larger than 9th-grade classes, the grading system, disengaged students or under-involved parents.

Years of institutional classism and racism have a stranglehold on our kids and our community. We have segregated our children by poverty and race into a few schools that are challenged with getting each of their students to meet the standards and meet the basic needs they come to school without.

Why should we care? If our kids are in a "good" school, surely that is enough. As long as our kids' school has a lower failure rate than some of those "other" schools, I suspect that when failure data is reviewed there is a collective sigh of relief in the upper middle class, primarily Caucasian, neighborhoods.

Failure of one student within our entire system is a failure to us all. The No Child Left Behind legislation promised higher standards for all kids, and this educator believes that by and large teachers, classroom assistants and administrators across Washoe County are breaking their backs to try to make this a reality.

The unfortunate truth is that our policy and law makers have only extended the accountability of No Child Left Behind to the school system.

Can you imagine how much lower the failure rate might be for 9th-graders at my school if No Child Left Behind meant:

The failure rate of 9th-graders is a huge issue that is largely related to our failure as a community to "Leave No Child Behind" in providing for their basic needs. The failure rate in the school system is a noose around the necks of poor and minority kids who are funneled into a few high schools and live in communities that are unsafe, impoverished and plagued with parents/guardians frequently working multiple jobs to support the economy that makes so many of us comfortable.

As the principal of Procter R. Hug High School, I am deeply committed to the success of each of my kids. I have no doubt that the intense work of our innovative staff and the commitment of the school district will over time allow us to transform our school community. This will happen gradually and will be the result of our school community bonding together to find a way to not only improve pedagogy in the classroom but also to transform the environment in which many of our kids must live.

I invite each of you to consider your role, if not as a classroom teacher or administrator, then as a part of our community that, unless challenged, will be comfortable with the status quo -- the classism and racism that has held our kids and families from poverty down for years. If we are really going to "Leave No Child Behind" in Reno/Sparks it is going to take a much more focused, equitable approach than currently exists.

Andrew E. Kelly is the principal at Hug High School.

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